Arthroscopic management of elbow stiffness

AbstractThe elbow is particularly prone to stiffness. Loss of elbow motion is very limiting, and can be the result of trauma, primary osteoarthritis, heterotopic ossification and other conditions. Several exposures have been described for open elbow contracture release. Although a few decades ago elbow arthroscopy was considered only for diagnosis and removal of loose bodies, contemporary arthroscopic techniques allow successful management of the majority of conditions leading to elbow stiffness. Careful patient evaluation, use of advanced imaging studies, and acquisition of appropriate surgical skills are essential for the successful arthroscopic management of the stiff elbow. This expert opinion reviews some fundamentals of elbow stiffness as well as principles for the evaluation and arthroscopic management of the stiff elbow.

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Arthroscopic Treatment of Stiff Elbow

ISRN Surgery ◽

10.5402/2011/378135 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Davide Blonna ◽

Enrico Bellato ◽

Eleonora Marini ◽

Michele Scelsi ◽

Filippo Castoldi

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Conservative Treatment ◽

Range Of Motion ◽

Arthroscopic Management ◽

Acceptable Range ◽

Stiff Elbow ◽

Tissue Trauma ◽

Elbow Contracture

Contracture of the elbow represents a disabling condition that can impair a person's quality of life. Regardless of the event that causes an elbow contracture, the conservative or surgical treatment is usually considered technically difficult and associated with complications. When the conservative treatment fails to restore an acceptable range of motion in the elbow, open techniques have been shown to be successful options. More recently the use of arthroscopy has become more popular for several reasons. These reasons include better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion. The purpose of this paper is to review the indications, complications, and results of arthroscopic management of a stiff elbow.

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Arthroscopic Management of Synovial Chondromatosis of the Knee Joint

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34429 ◽

2021 ◽

pp. 651-656

Author(s):

V. S. Gowtham ◽

. Mervinrosario ◽

Vaishak Bhat

Keyword(s):

Case Report ◽

Knee Joint ◽

Viscous Fluid ◽

Efficient Method ◽

Histopathological Examination ◽

Synovial Chondromatosis ◽

Left Knee ◽

Loose Bodies ◽

Benign Condition ◽

Arthroscopic Management

Synovial Chondromatosis is a rare and it is a benign condition characterized by multiple cartilaginous nodules in synovial facet spaces. Synovial Chondromatosis affects most commonly the knee joint. This is a case report of a 30-year-old male patient presented with pain and swelling over the left knee joint. On evaluation MRI shows loose bodies, for which he underwent, arthroscopic exploration. Viscous fluid and loose bodies were identified and showed synovial hyperemia. Synovial debridement was done and loose bodies were removed and sent to histopathological examination. The result signify that arthroscopy is efficient method both in diagnostic as well as therapeutic management of synovial chondromatosis.

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A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness

Obere Extremität ◽

10.1007/s11678-019-00544-1 ◽

2019 ◽

Vol 14 (4) ◽

pp. 263-268 ◽

Cited By ~ 1

Author(s):

T. Leschinger ◽

M. Hackl ◽

M. Lenz ◽

V. Rausch ◽

L. P. Müller ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Dash Score ◽

Open Approach ◽

Elbow Stiffness ◽

Short Term ◽

Open Arthrolysis ◽

Stiff Elbow ◽

Prospective Comparison ◽

Elbow Movement

Abstract Background Surgical treatment of the stiff elbow can be performed either arthroscopically or via an open approach. There is a paucity of direct prospective comparisons of the techniques in the literature. Objectives The aim of the study is to analyze the clinical short-term results of arthroscopic and open elbow arthrolysis in postoperative and posttraumatic stiff elbows. Materials and methods The study group consisted of 44 patients divided in two cohorts, one after arthroscopic arthrolysis (33 patients) and the other including patients after open arthrolysis (11 patients). Range of motion (ROM; extension/flexion), pain (numerical rating scale, NRS), as well as the disabilities of the arm, shoulder, and hand (DASH) score were recorded preoperatively and examined in a standardized manner 6 weeks, 3 months, and 6 months after surgery. Results In both groups, preoperative elbow movement significantly improved in the follow-up. An increase from 103.3° (±23.4) to 123.5° (±12.5°; p = 0.001) was seen after 6 months for the arthroscopic group, whereas the mean ROM significantly increased from 64.5° (±31.1°) to 100.9° (±25.6°; p = 0.007) following open arthrolysis. In the arthroscopic group, the DASH score was measured at 37.3 points (±23.4 points) and improved to 16.1 points (±16.5 points) after 6 months, while in the open group it enhanced after 6 months (19.5 points [±17.5 points]) compared to its preoperative value by 38.2 points (±24.1 points). A consistent improvement was found for NRS, which decreased after surgery in both groups (arthroscopic group = −3.1 [±3.0]; open group = −2.0 [±2.9]). Complications did not occur in either group. When comparing delta values of the groups between the preoperative ROM, DASH score, and NRS, no significant differences were observed (p < 0.05). Conclusions Good to excellent functional recovery was seen in both cohorts when evaluating for improvement in the DASH score, the gain in elbow motion, and the decrease in pain. No significant differences were found between the procedures regarding pre- and postoperative measurements. The arthroscopic approach has developed to become an effective alternative to treat posttraumatic elbow stiffness.

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The stiff elbow: Current concepts

Orthopedic Reviews ◽

10.4081/or.2020.8661 ◽

2020 ◽

Author(s):

Giulia Masci ◽

Gianpiero Cazzato ◽

Giuseppe Milano ◽

Gianluca Ciolli ◽

Giuseppe Malerba ◽

...

Keyword(s):

Conservative Treatment ◽

Continuous Passive Motion ◽

Anatomical Location ◽

Tissue Elasticity ◽

Elbow Stiffness ◽

Granulation Tissue Formation ◽

Stiff Elbow ◽

The Stability ◽

Surgical Drain ◽

Degree Of Severity

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay’s classification), anatomical location (Morrey’s classification), or on the degree of severity of rigidity (Vidal’s classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

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